Last summer, the 17-hospital Essentia Health system began a transition in which the operations of several organizations – including SMDC Health System, Brainerd Lakes Health, Innovis Health – were combined under one roof. For Innovis CIO Ken Gilles, it meant relinquishing some of the decision-making to Dennis Dassenko, Essentia’s CIO, which was just fine by him. Gilles believes that the new position will enable him to expand his current role while taking on some corporate-level responsibilities, particularly as Essentia rolls out the Epic EMR system-wide. In this interview, Gilles talks about how he is managing the transition, the importance of physician buy-in, the challenges of a geographically disparate health system, and how government initiatives are impacting his organization’s IT strategy.

Chapter 1

About Essentia health

Turning three regions into one enterprise

From Innovis to Essentia

Going full-boat Epic (Lawson for financials, supply chain, etc)

Measuring up to Meaningful Use — “We have engaged the administrative team to make this the top priority of the organization”

“It was certainly a strategic initiative for all of Essentia to be on one system. So as caregivers move from one region into the other, the patients don’t have to know the difference, the physicians don’t know have to know the difference. They’re using the same systems wherever they go.”

“In my position as the associate CIO, there are a lot of things that still go across my desk. I’m certainly not the final decision maker or approver as I was in a lot of cases as the CIO, but from a positive standpoint, I still feel like I’m in the loop.”

“We couldn’t do it without that partnership. We have had these teams engaged from day one when we made the decision, which was a little over a year ago now, and it’s worked very well. Getting the right physician sponsors is probably the key beyond having the organization make it the number one priority.”

“Having a hospital and then clinics that are all within a couple of miles is very different from when we go live in Fargo, and the clinics are 90-plus miles away. The number of support staff we’re going to need and the ability to move people from one side to the other if there’s hotspots when you are implementing is going to be very, very different.”

Guerra: Good morning Ken, thanks for being with me today. I look forward to chatting with you about your work at Essentia Health, where you are now CIO of the West Region.

Gilles: Good morning.

Guerra: Tell me a little bit about Essentia Health. First off, I know there’s been a merger and some organizations have come together, and we’ll get to some of that. But tell me about some of the basics of Essentia Health some of the basics so that the listeners can get a little context.

Gilles: Essentia Health was actually formed by bringing three regions together: the west region, central region and east region. Essentia’s headquarters are in Duluth, Minn. Over the past couple of years, we’ve been going through some major integration efforts across all of these regions to bring things together—the care process, the systems infrastructure, service departments and those types of things.

Guerra: And we’re talking about multiple hospitals in each region?

Gilles: Right.

Guerra: How many hospitals do you oversee as CIO?

Gilles: Dennis Dassenko is actually the CIO of Essentia Health. I’m the CIO of the west region, where we have five hospitals.

Guerra: So you are the regional CIO over five hospitals.

Gilles: Right.

Guerra: And approximately how many combined beds are in your five hospitals—just a rough number.

Gilles: I’d say about 250-plus.

Guerra: That’s in each facility or combined?

Gilles: That’s combined.

Guerra: So they’re small facilities?

Gilles: Yes. I think the largest is about 104 beds, followed by 58, and then we have some critical access hospitals as well.

Guerra: Before Essentia came together, what was your role? You were CIO of those five hospitals or one of the hospitals?

Gilles: I was actually the CIO of Innovis Health, which was one hospital and 21 clinics.

Guerra: Okay, so now Innovis is part of Essentia?

Gilles: Yes. Innovis is actually Essentia Health now.

Guerra: Okay, so tell me about the transition. Was this a big adjustment in your career? Was this essentially like taking on a new role or was it a pretty smooth transition?

Gilles: You know it was actually a very smooth transition, but it was in effect, taking on a very different role. And quite honestly, for me it’s worked out very well. I’ve assumed the regional role, which has expanded from one hospital to five and a number of clinics, and I also have a role at the corporate level—at the Essentia Level, as the associate CIO. So for me it’s been just a good blend of expanding my current role and also taking on some corporate level responsibilities.

Guerra: Tell me about the application environment at the five hospitals?

Gilles: At the current environment?

Guerra: Yes; when you say ‘current,’ that would indicate that you’re transitioning.

Gilles: Yes.

Guerra: Okay, so tell me what you’re on, and tell me about the transition plan.

Gilles: So currently, the hospitals are on different disparate systems, and one of the goals of Essentia Health is an integrated delivery system across the entire health system. So we’re in the process of migrating the entire organization to the Epic platform for the clinical and revenue cycle, and Lawson for the financials, ERP and supply change management. And then where we can, we’re looking to integrate with other systems—lab, document imaging, and radiology PACS, those types of things. So we’re going through major, major systems integration right now.

Guerra: Were you involved with the decision to go with Epic?

Gilles: I would say partly for our region. The reason I say that is the east region had been using Epic for about six or maybe seven years in the clinics. So the decision was made to migrate that to the hospitals, and then the decision was made as our administrative team in the west region deciding to go with Epic, and also the central region as well. But it was certainly a strategic initiative for all of Essentia to be on one system. So as caregivers move from one region into the other, the patients don’t have to know the difference, the physicians don’t know have to know the difference. They’re using the same systems wherever they go.

Guerra: What’s your time line on this project, in terms of implementation, these types of things?

Gilles: To get out to the way end, I’d say 2013. We will have the majority of the regions up by the end of 2012, but there are going to be a few other smaller critical access hospitals that will go into 2013.

Guerra: Do you think you’ll make Stage 1 of meaningful use?

Gilles: In most cases, yes. And by most cases, I mean that, like I said, there will be a couple critical accesses that might be right on the edge for the first year.

Guerra: So that’s interesting. As a CIO of the Western Region, I would imagine most of the contracting with the vendor is handled by Dennis Dassenko at the enterprise level; at the corporate level. Are there some things that you are not involved in now that you used to be involved with as CIO that are now handled on the corporate level?

Gilles: Absolutely. The good thing for me is that in my position as the associate CIO, there are a lot of things that still go across my desk. I’m certainly not the final decision maker or approver as I was in a lot of cases as the CIO, but from a positive standpoint, I still feel like I’m in the loop. And some of those things you’ve done enough times that you kind of feel okay with letting it go to another group. So it’s been a good transition.

Guerra: In a way, it’s nice to have some things taken off your plate—at least the vendor negotiation. Not that Epic negotiates, but all of that type of stuff.

Gilles: Absolutely.

Guerra: Give us your thoughts on laying the ground work in your hospitals. I don’t know if you had much CPOE going with the physicians, but laying the ground work to take delivery of the software and get it implemented.

Gilles: We have not done any CPOE, nor have we done physician documentation and those types of things. A lot of the implementations that we had in place for EHR were to the point where the nurses were utilizing the system and entering data and the physicians were the recipients; they could view data but didn’t do a whole lot of entry.

And now we have engaged the administrative team to make this the top priority of the organization so there’s that buy-in at the senior administration level, and we’ve gotten our physician champions in place—our CMO and those types of folks who are literally selling this throughout the organization alongside the IT folks. But it’s a great partnership and quite honestly we couldn’t do it without that partnership. We have had these teams engaged from day one when we made the decision, which was a little over a year ago now, and it’s worked very well. Getting the right physician sponsors is probably the key beyond having the organization make it the number one priority.

Guerra: You mentioned the chief medical officers, but I would imagine that most of the physicians are independents typically in the community setting?

Gilles: No, for the most part these are our physicians—employed physicians. There are maybe some independents, but for the most part, they’re employed physicians of the organizations.

Guerra: All right. So you’re in a rural area? Is that correct?

Gilles: Yes.

Guerra: Are there special challenges with doing this in small facilities as opposed to 500, 600 or 800-bed hospitals? And are there special challenges with doing five small facilities that maybe have a quite a distance between them?

Gilles: I think the geographic disparity is one of our biggest challenges. I’ll give you an example—we literally just went live with the Epic system here. I’m actually in Brainerd, Minn. right now, and it’s a 270-bed hospital, I believe. But having a hospital and then clinics that are all within a couple of miles is very different from when we go live in Fargo, and the clinics are 90-plus miles away. The number of support staff we’re going to need and the ability to move people from one side to the other if there’s hotspots when you are implementing is going to be very, very different. So we’re ramping up in a different way for Fargo than we did for Brainerd.We’re bringing in about 25 interns and college students to help out with go-live support and bringing in folks from each of the regions to help out so that we can cover and have enough staff at each of the sites when we go live. So it’s going to be quite a challenge.

Guerra: Do you end up putting a lot of mileage in your car?

Gilles: Actually, about two or three years ago I was talking to my wife and I was saying, ‘You know what? I wouldn’t mind getting a job where I could travel a couple of days a week.’ I’ll tell you what; be careful what you wish for, because that’s what I’m doing now. I do a couple of days a week up there, but I’ve got it down to where every other week I go to Duluth for two or three days, and then spend some time in Brainerd—that sort of thing. So it hasn’t been too bad.